mcalonzo2000
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Diagnosis:
1. Lumbar disc protrusion
2. Lumbar radiculopathy
3. Lumbar facet hypertrophy
Procedure:
1. Lumbar epidural steroid injection at L4-L5
2. Bilateral facet joint injection at L4-L5 and L5-S1
3. Interpretation of arthrograms of facet joins L4-L5 and L5-S1
4. Epidurogram
5. Injection of Marcaine and Depo-Medrol
6. Fluoroscopy
At L4-L5, 10 cc of 1% Lidocaine was used to infiltrate the area with #25-gauge needle. Next, a #17-gauge, 3.5-inch Tuohy needle was inserted and advanced until good loss of resistance to normal saline was obtained at this level. After negative aspiration for blood or CSF, 3 cc of Isovue-200 was injected, which showed diffuse epidurogram at L4-L5, which was then confirmed on the lateral position. Then, a solution containing 4 cc of 0.25% Marcaine and 40 mg of Depo-Medrol was injected, which showed the same distribution as the dye.
The L4-L5 and L5-S1 facet joints were identified by fluoroscopy unit in the oblique position. A 25G Quincke tip needle was then advanced to each joint under fluoroscopy. The similar routine was then repeated for the other side. Next, the positions of all needles were confirmed, and each one was injected with a solution containing 0.5 cc Isovue solution, which revealed arthrogram of each joint. Then, each facet joint was injected with 0.5 cc of 0.25% Marcaine and 10 mg of Depo-Medrol.
All the needles were then removed. The areas were cleaned and covered with Band-Aid.
The patient tolerated the procedure well and was taken to the recovery room and discharged home in a good condition with a follow-up visit with me at my office.
Diagnosis:
1. Lumbar disc protrusion
2. Lumbar radiculopathy
3. Lumbar facet hypertrophy
Procedure:
1. Lumbar epidural steroid injection at L4-L5
2. Bilateral facet joint injection at L4-L5 and L5-S1
3. Interpretation of arthrograms of facet joins L4-L5 and L5-S1
4. Epidurogram
5. Injection of Marcaine and Depo-Medrol
6. Fluoroscopy
At L4-L5, 10 cc of 1% Lidocaine was used to infiltrate the area with #25-gauge needle. Next, a #17-gauge, 3.5-inch Tuohy needle was inserted and advanced until good loss of resistance to normal saline was obtained at this level. After negative aspiration for blood or CSF, 3 cc of Isovue-200 was injected, which showed diffuse epidurogram at L4-L5, which was then confirmed on the lateral position. Then, a solution containing 4 cc of 0.25% Marcaine and 40 mg of Depo-Medrol was injected, which showed the same distribution as the dye.
The L4-L5 and L5-S1 facet joints were identified by fluoroscopy unit in the oblique position. A 25G Quincke tip needle was then advanced to each joint under fluoroscopy. The similar routine was then repeated for the other side. Next, the positions of all needles were confirmed, and each one was injected with a solution containing 0.5 cc Isovue solution, which revealed arthrogram of each joint. Then, each facet joint was injected with 0.5 cc of 0.25% Marcaine and 10 mg of Depo-Medrol.
All the needles were then removed. The areas were cleaned and covered with Band-Aid.
The patient tolerated the procedure well and was taken to the recovery room and discharged home in a good condition with a follow-up visit with me at my office.